The Social Determinants of Health

Social Determinants

The social determinants of health are those factors which are outside of the individual; they are beyond genetic endowment and beyond individual behaviors. They are the context in which individual behaviors arise and in which individual behaviors convey risk. The social determinants of health include individual resources, neighborhood (place-based) or community (group-based) resources, hazards and toxic exposures, and opportunity structures.

– Camara Jones, CDC, 2010

Social Determinants of Health

Two thousand years (up to 1850s):• Illness as humors out of balance• Physician investigated a patient’s environment & habits• No clear distinction between public and personal health

By 1930s:• Illness as disruption of the body by an invading organism• Physician treats individual patients; public health professionals deal with

epidemics & environment – Jeff Brosco

History of Medical Care in the US

1850s • General practice• Varied training• Rural/local/isolated• Low income/prestige• +/-State license• Pre-germ theory• Eclectic therapies

1930s• Specialization• Standardized training• Urban/connected• Reasonable income/prestige• License required• Scientist as hero

– Jeff Brosco

Hospital Operating Suite, c.1910

Health Equity

• Where systematic differences in health are judged to be avoidable by reasonable action they are, quite simply, unfair. It is this that we label health inequity.

• Putting right these inequities – the huge and remediable differences in health between and within countries – is a matter of social justice.

– World Health Organization Commission on Social Determinants of Health

Health Disparities (Birth Outcomes)

1970s –2000: solution to disparities is improve health care• Better/more accessible prenatal care• Better/more accessible neonatal care

Governmental and private actions improved prenatal care rates and decreased disparities in health care, but poor outcomes worsened and disparities increased

“You can’t cure a lifetime of ills in nine months of a pregnancy”

– Milton Kotelchuck

Infant Mortality(U.S. Bureau of Statistics)

The New 21st Century Scientific Basis for the MCH Life Course

• Provides an understanding of how the social environment gets built into or embodied into our physical bodies

• Bridges our intuitive understanding of the social causes of ill health (poverty, malnutrition, stress) with our understanding of its clinical manifestations and treatment

• Incorporates our growing scientific understanding of the biology of human development into our health trajectories

• Focuses on root causes of illness and disparities

– Cheri Pies